MHA members were among those who virtually attended the webinar Collection of Sexual Orientation Gender Identity (SOGI) Data Best Practices for the Acute Care Setting. The event was hosted Nov. 10 by the Michigan Public Health Institute, the Michigan State University Institute for Health Policy, the MHA Keystone Center and Fenway Health. This training featured Chris Grasso, vice president, health informatics and data services, and Alex Keuroghlian, MD, director of the division of education and training at Fenway Health, who discussed best practices for collecting and documenting patient SOGI data in electronic health records.
Hospitals and health systems are experiencing a decrease in routine inpatient admissions, prompting development of other services. One of these services is post-acute care, which is expected to grow as the population ages and skilled nursing facilities (SNFs) are expanded and created. To build skilled nursing growth, providers use data focused on referral patterns to develop specialized programs based on patient needs, then promote those specialized services.
The MHA webinar Using Data to Grow Skilled Nursing Facility Admissions will explain each step of this strategic process, including real-world success stories demonstrating the value of this approach.
MHA members are invited to participate in the webinar Collection of SOGI Data Best Practices for the Acute Care Setting, which will be held 9:30 to 11:30 a.m. ET Nov. 10. In this training, Chris Grasso, vice president, health informatics and data services, and Alex Keuroghlian, MD, director of the division of education and training, Fenway Health, Boston, discuss best practices for collecting patient sexual orientation and gender identity (SOGI) data and documenting SOGI in electronic health records. Registration is free for all Michigan hospitals.
As a result of the webinar, participants will be able to:
- Summarize how to incorporate SOGI data collection into their workflow, using their electronic health records and quality improvement techniques to improve communication, quality care, and data and quality management activities.
- Identify at least one method to actively engage and educate staff on the importance of collecting and using SOGI data, how to do so, the data’s impact on health disparities, and how SOGI can be used to direct education and clinical practice.
- Identify at least one training, tool or another resource to assist their organizations in collecting and using SOGI data.
Members with questions may contact the MHA Keystone Center.
The Michigan Public Health Institute and the MHA Keystone Center are hosting a webinar to illustrate the importance of data collection specific to LGBTQ+ patients. LGBTQ+ Informed Care: It Starts with Data is a free event and will be held from 10 to 11 a.m. Aug. 19.
The current lack of data on LGBTQ+ patients leaves healthcare providers without the research needed to understand safety for these patients. To effectively address LGBTQ+ health issues and disparities, healthcare organizations need to collect patient demographic information securely and consistently. During this webinar, participants will differentiate data collection methods and processes for different generations of LGBTQ+ patient populations.
The event speakers will also discuss the significant amount of work that remains to protect LGBTQ+ Michiganders from discrimination in healthcare, particularly in rural and small-town communities.
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve the electronic exchange of healthcare data among providers, patients and payers by streamlining prior authorization processes through Application Programming Interfaces. The proposed requirements would affect Medicaid and Children’s Health Insurance Programs and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). Medicare Advantage plans are excluded from this proposed rule. If the rule is finalized as proposed, the requirements would take effect Jan. 1, 2023, and impact the following areas:
- Patient Access Application Programming Interface (API): The proposed rule would require payers to permit third-party applications to retrieve certain data through a Fast Healthcare Interoperability Resources® API at the direction of an enrollee. At a minimum, the payers would be required to make available adjudicated claims, encounters with capitated providers and clinical data. Under, the proposal, clinical data must comply with the United States Core for Data Interoperability version 1 content and vocabulary standards, and data must be made available no later than one business day after a claim is adjudicated or encounter data are received. The proposal indicates the API must conform with Health Level Seven International® standards, and data with a date of service on or after Jan. 1, 2016, must be made available.
- Provider Access APIs: Payers would be required to build and maintain a publicly accessible Provider Access API for payer-to-provider data sharing of claims, encounter data, and pending and active prior authorization decisions starting Jan. 1, 2023. The CMS would not allow payers to deny use of the Provider Access API based on whether the provider has a contract with the payer. It believes that providers should have access to their patients’ data regardless of their relationship with the payer. However, a nonnetwork provider would have to demonstrate that it has a care relationship with the patient. Payers would be required to establish and maintain a process to verify each provider’s current beneficiary roster to enable appropriate data sharing via the Provider Access API.
- Documentation and Prior Authorization Burden Reduction through APIs: The CMS intends to alleviate documentation and prior authorization administrative burdens by using APIs.
- Document Requirement Lookup Service API: The CMS proposes to require payers to build and maintain a Document Requirement Lookup Service API that could be integrated with an electronic health record to allow providers to electronically locate prior authorization requirements for each specific payer.
- Prior Authorization Support API: The CMS proposes to require payers to build and maintain a Prior Authorization Support API that has the capability to send prior authorization requests and receive responses electronically.
- Denial Reason: The CMS proposes payers include a specific reason for a denial when denying a prior authorization request, regardless of the method used to send the prior authorization decision.
- Shorter Prior Authorization Timeframes: The CMS proposes to require payers (not including QHP issuers on the FFEs) to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests.
- Prior Authorization Metrics: The CMS proposes payers publicly report data about their prior authorization process, such as the percent of prior authorization requests approved, denied and ultimately approved after appeal; and average time between submission and determination.
- Payer-to-Payer Data Exchange: The CMS proposes payers be required to maintain a process for the electronic payer-to-payer data exchange. Under this payer-to-payer data exchange, payers must send and receive data on current enrollees and for up to five years after enrollee disenrollment. This data would need to be incorporated into the payer’s enrollee record. To satisfy this requirement, payers would be able to use multiple methods for electronic exchange of information — a standards-based API was encouraged, but was not a proposed requirement.
Members with questions should contact Renée Smiddy at the MHA.
Developments with the novel coronavirus are occurring quickly, as the first shipments of the Pfizer COVID-19 vaccine have gone out and the federal government continues to grapple with legislation to assist American businesses and residents. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Healthcare Community Urged to Contact Congress on COVID-19 Relief
As the 116th U.S. Congress is entering its final weeks, a COVID-19 relief package is still being negotiated. A bipartisan group of senators led by Sens. Joe Manchin (D-WV) and Mitt Romney (R-UT) is proposing more than $900 billion in aid for state and local governments, small businesses and healthcare providers. Transportation, unemployment, education, vaccine distribution, and testing and tracing are also included in the package. Funding for healthcare providers includes $35 billion allocated to the Provider Relief Fund (PRF), with $7 billion for rural providers and $1 billion for tribes, tribal organizations, urban Indian health organizations and health service providers to tribes. The plan also includes improvements to PRF reporting guidelines, such as clarification that PRF can be used for staffing, including child care staff, and health systems are allowed flexibility to move targeted PRF distributions within their system. It is possible the bipartisan package could be formally introduced Dec. 14.
Hours before funding for the federal government expired Dec. 11, Congress approved a one-week funding extension to Dec. 18. The extension provides negotiators with several more days to agree to a Continuing Resolution for all government funding and a COVID-19 relief package. Members are asked to contact their U.S. House representative and Michigan Sens. Debbie Stabenow and Gary Peters to encourage the following support for hospitals in the end-of-year package:
- Provide more COVID-19 relief, including additional money for the PRF, federal liability protections, support for front-line healthcare workers, coverage for the uninsured, and accelerated payment forgiveness.
- Eliminate cuts to the Medicaid disproportionate share hospital program in the next fiscal year.
- Extend the congressionally enacted moratorium on the application of the Medicare sequester cuts until the public health emergency ends.
Members are also asked to urge that the following provisions be excluded from any package that reaches the House or Senate for a vote:
- Problematic proposals under consideration related to surprise medical billing, including any “agreement” that takes money from providers without protecting patients.
- Any provisin that would require new, unrealistic and burdensome Occupational Safety and Health Administration standards.
With strong advocacy from the healthcare community, Congress could pass a COVID-19 Relief Package before adjourning for the year. For more information about end-of-year federal activity, members may contact Laura Appel at the MHA.
Pfizer Vaccine Approved and Being Shipped, Priority Groups Finalized
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization determination for the Pfizer COVID-19 vaccine late Dec. 11 and shipments began leaving Kalamazoo Dec. 13.
The Michigan Department of Health and Human Services (MDHHS) had provided additional information about COVID-19 vaccination plans for the state earlier Dec. 11, including priority groups for vaccination administration. The MDHHS slides from the news conference are available online.
The MDHHS is following the recently issued Centers for Disease Control and Prevention recommendations for prioritization of distribution and administration of COVID-19 vaccines. CDC recommendations are based on input from the Advisory Committee on Immunization Practices (ACIP). In addition, multiple health systems and the MHA took part in a stakeholder meeting in November to provide input on Michigan’s priority groups.
- Phase 1A includes paid and unpaid individuals serving in healthcare settings who have direct or indirect exposure to patients or infectious materials and are unable to work from home, as well as residents of long-term care facilities.
- Phase 1B includes some workers in essential and critical industries, including workers with unique skill sets such as nonhospital or nonpublic health laboratories and mortuary services.
- Phase 1C includes people at high risk for severe COVID-19 illness due to underlying medical conditions and people 65 years and older.
- Phase 2 is a mass vaccination campaign for all adults.
The MDHHS vaccination plan includes additional prioritization guidance within these categories. It was stressed that vaccination in these phases will likely overlap. The timing of the start of vaccination in a phase is dependent on guidance from the CDC and the ACIP, the supply of vaccine from the manufacturer, how vaccine is allocated from the federal level to Michigan and the capacity to administer the vaccine to populations.
The MHA will continue to provide updates on vaccine distribution as they become available. Members who receive updates directly from the MDHHS are encouraged to share that information with the MHA for vetting or broader distribution. Members with questions and information may contact Ruthanne Sudderth at the MHA.
MDHHS “Pause” Extended to Dec. 20
The MDHHS announced Dec. 7 that it was extending to Dec. 20 its Nov. 18 emergency order limiting indoor gatherings and requiring mask wearing. Previously set to expire at midnight Dec. 8, the extended order slightly relaxes some of the previous order’s restrictions; for example, it allows for in-person instruction of certain trade/vocational programs, with protections in place.
The MDHHS announcement comes on the heels of the MHA’s Dec. 7 letter, published on behalf of MHA-member chief medical officers, urging the state to continue some degree of protection so that the slight progress in hospitalizations achieved since Nov. 18 does not regress. The MHA also issued a statement recognizing the order extension following the MDHHS announcement and has conducted media interviews with outlets from across the state. Links to some of the media coverage is available in a related article.
Data Tracking COVID-19 Patients, New Reporting Requirements
- Hospitals have asked for clarification on how to count patients who are no longer in COVID-19 isolation for reporting into the state’s EMResource portal or the national TeleTracking portal. According to guidance from the U.S. Department of Health and Human Services (HHS), COVID-19 patients should continue to be counted in the COVID-19 daily census and COVID-19 ICU census regardless of their isolation status or change in location (e.g. transferred out of a COVID-19 unit). Once a patient has been identified as COVID-19-positive, they should always be counted in your daily COVID-19 census until discharged or expired. Only the data field that pertains to hospital onset COVID-19 patients should take into account the change in COVID-19 isolation status.
- The HHS recently released new COVID-19 reporting guidance for hospitals. The influenza data fields will be mandatory (except psychiatric and rehabilitation facilities) starting Dec. 18. In addition, beginning Jan. 8, 2021, new therapeutic fields will be mandatory each Wednesday. These fields will be designated with generic identifiers (currently using only the letters A and B) to provide flexibility to the HHS on new therapeutics. Therapeutic A has been designated for Casirivimab/Imdevimab and therapeutic B has been designated for Bamlanivimab data collection.
Members with questions on data should contact Jim Lee at the MHA.
COVID-19 Webinar Series Available for All Hospitals
A weekly Mi-COVID19 webinar series began Dec. 9 that aims to continue collaboration and share COVID-19-related lessons learned with stakeholders and experts across multiple disciplines to support Michigan hospitals and providers in caring for COVID-19 patients. The series is hosted by the Mi-COVID19 Initiative, part of the Michigan Hospital Medicine Safety Consortium.
These webinars will be held from noon to 1 p.m. each Wednesday and are currently scheduled through Feb. 24. Webinar topics and registration information are available online.
CME/CE credit is being offered for each webinar. The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For information on future webinars, webinar recordings and COVID-related resources, visit the Mi-COVID19 Initiative webpage. To share COVID-19-related resources, contact the Mi-COVID19 leadership team.
An additional series of education webinars for providers on COVID-19 vaccine is available from the MDHHS. Three 30-minute presentations will be offered from noon to 12:30 p.m. on the following dates and can be joined via the appropriate link:
- Dec. 14: An Update on the Pfizer COVID-19 Vaccine
- Dec. 21: An Update on the Moderna COVID-19 Vaccine
- Dec. 22: Talking Points for Common COVID-19 Vaccine Concerns
No registration is required for these three webinars, and no continuing education credits are offered. Recordings will be made available for those who are unable to attend.
Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:
The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.
State Budget Deficit Deal Contains no Healthcare Cuts
Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.
In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.
The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.
Additional Allocation and Guidance Announced for Remdesivir
The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.
Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.
The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient's profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.
One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements
The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.
To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.
AHA Releases New COVID-19 Financial Impact Report
The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.
Delays in Unemployment Insurance Benefits
Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims may contact Neil MacVicar at the MHA.
Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:
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The MHA Service Corporation (MHASC) convened a meeting of its board Jan. 30 to assess and further develop programs and services to support key initiatives in the 2019-2020 MHA Action Plan.
The board received a report on activities of the MHA Enhanced Data Task Force, which was established to identify data priorities, pilot initiatives, governance and privacy issues, and value propositions, providing guidance and recommendations to the MHA Board of Trustees. The MHASC Board continued to discuss how best to position the association and its members to collect and use data to drive improvements in population health, advance advocacy objectives, and serve members’ operational needs. The MHASC Board also received an update on the Centers for Medicare & Medicaid Services rules for price transparency and discussed their impact at the federal and state levels.
In addition, the MHASC held the inaugural meeting of its Human Resources Committee to address current issues, consider future healthcare workforce needs, and provide input to the MHASC Board on innovative solutions to improve value and performance. Workplace safety and wellbeing is an MHA strategic priority and is supported by education and training from MHA Endorsed Business Partner HSS and efforts of the MHA Workplace Safety Collaborative. The committee provided feedback on activities in these areas and reviewed the initial charter. Its next meeting will be held in conjunction with the Michigan Healthcare Human Resources Conference in March.
The MHASC board welcomed its newly appointed members as approved by the MHA Board of Trustees at its last meeting, including Betty Chu, MD, MBA, associate chief clinical officer and chief quality officer, Henry Ford Health System, Detroit; Brian Connolly, retired CEO and chief transformation executive, Beaumont Health System, Southfield; Marita Hattem-Schiffman, president, MidMichigan Medical Center-Gratiot/Mt. Pleasant/Clare; and Kent Riddle, CEO, Mary Free Bed Hospital, Grand Rapids.
To learn about MHASC services available to MHA members, visit the MHA Business Services webpage. Questions on these options or about the MHASC board and human resources committee meetings should be directed to Peter Schonfeld at the MHA.